HIV self-testing a game changer: 'The earlier you go, the longer you live'

HIV self-testing a game changer: 'The earlier you go, the longer you live'

- Self screening for HIV infection is becoming as common as home pregnancy or ovulation tests as technology develops to help ensure greater percentages of populations know their HIV status

- Knowing your HIV status is essential to helping prevent the spread of HIV, and to ensure those who are possible are able to access treatment as early as possible

- The discrimination against HIV is still a huge barrier to efforts by NGOs to increase awareness of the virus

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Many more people than ever before are able to access testing for HIV that is both less invasive, and off-putting than the traditional tests which used to be needed to screen for the virus learned that projects in South African cities are helping to spread the awareness of how easy it is to get tested, and how beneficial this early testing can be to the well being of both infected and uninfected people whose lives are touched by HIV.

Teams using self-screening tests which take only 20 minutes and offer results that are more than 90% accurate are making inroads in the sphere of early and widespread testing.

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The test identifies the presence of the virus from a simple oral sample swabbed across the gums and then left in a tube of liquid for the reaction to take place.

Because of the ease of use and lack of a need for a clinician to be present, the new testing is making access to life saving health knowledge widely accessible to many who otherwise would never know their status. That in turn saves lives.

Mokgadi Mabuela, a counsellor, spends time in Hillbrow during the lunch hour rush distributing kits to passersby. “You can either do it here [in a private tent] or take the test home,” she explains to a group of men. “Inside [the kit], you find your stand [for the cylinder of liquid], the liquid and testing pen.”

Mabuela says it is not uncommon to encounter people taking their first test. While many suspect they might be HIV positive, some say they haven’t felt ready to find out, and the old methods of testing put them off even going for a test.

“They are just scared to know. It’s just the thing of knowing you could be positive that’s quite scary,” she explains. “Especially in a place like Hillbrow where you have your brothels, strip clubs and everything. The discrimination that comes with having HIV is still a huge thing.”

This is why the services of counsellors and staff dealing with people in their own communities is so important.

Previously people wanting to be tested would have had to queue for hours at a health facility. The stigma attached to HIV means many worried about being seen by friends or neighbours while seeking out help. The immediacy, privacy, and discretion of the self-testing kits overcome these problems.

At the moment South African government figures estimate that approximately 86% of people in the country know their HIV status. The United Nations would have that statistic rise to the 90%. It is believed that the self-testing kits might go a long way towards helping to make that target a reality.

Pitfalls of self-testing

However there are some problems with the self-testing strategy. Vuyokazi Gonyela, deputy general secretary of Treatment Action Campaign (TAC), a civil society group concerned with helping people access treatment, says while she welcomes self-testing, it must be accompanied by quality counselling.

“It has to come in the form of a package. There needs to be education and understanding of what it means,” explains Gonyela who fears that to not offer this support increases risk of domestic violence, self-harm or even coercive testing. However thus far, fears of these impacts have proven to be unfounded based upon existing statistics.

“We need to be mindful of the psychological state that we put our people into, because this then challenges the extent to which we are able to unpack our treatment, care and support programme,” says Gonyela.

There have been measures put in place to prevent gender-based violence or coercive testing. Men cannot take home an extra kit for a partner, although women are allowed to do so.

After testing what next?

Mpumelelo Sibanda, the self-screening site coordinator at the Hillbrow project says those who are given a self-screening kit in Hillbrow are required to give their details to counsellors first, and are given advice on what to do with their result. Inside, there’s a referral sheet with a list of clinics, a card that can be presented to a nurse, and a phone number.

“I get a lot of calls,” says Sibanda. “People text me on WhatsApp saying, ‘I need to speak to you now’ … People are in a state of panic, so they want to be seen soon.”

Sibanda says normally people who have tested positive can be seen the next day at which time they are given a second test to confirm the results and help them to access treatment.

If they are ready to do so, people can start antiretroviral treatment right away joining the 3.7 million people in South Africa already on antiretroviral treatment.

Gonyela warns that the emphasis of “chasing numbers” might lead to a decline in the quality of care each person receives. This could contribute to a higher drop out rate from treatment programmes. “People get tired [of taking treatment], that’s a reality,” explains Gonyela who hears this story from patients day in an out. She does feel that letting people know that the minute deviate from their courses of medication, they giving HIV the opportunity to rise above your CD4, has an impact. “That’s the type of information that people really want to understand,” she says.

As one patient who elected to take his test home explained, attitudes are slowly changing. “People [taking treatment] are living longer than those who don’t report,” he said adding that within all communities there are people who have died because they kept their infection a secret.

“Now they see, the earlier you go, the longer you are going to live. People are not shy, they go get their treatment,” he says. “They know the more they keep quiet, the more HIV attacks them.”

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